Healthcare Provider Details

I. General information

NPI: 1972606234
Provider Name (Legal Business Name): ROBERT J. WOLFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 PARK STREET
MALONE NY
12953
US

IV. Provider business mailing address

417 PARK AVE
SARANAC LAKE NY
12983-5529
US

V. Phone/Fax

Practice location:
  • Phone: 518-483-3261
  • Fax:
Mailing address:
  • Phone: 518-891-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number183046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: